Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 057928 | GA |
Y | 208600000X | Surgeon | 057928 | GA |
NPI | 1003012824 |
---|---|
Provider Name | Dr. Olufemi A Babalola |
First Address | Atlanta, GA 30303-2526 |
Second Address | East Point, GA 30344-6903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 25/05/2012 |